The first 24 hours of acute pancreatitis. Changes in biochemical and endocrine homeostasis in patients with pancreatitis compared with those in control subjects undergoing stress for reasons other than pancreatitis

As a group, 20 patients with acute pancreatitis showed alterations in biochemical and endocrine homeostasis that differed from the metabolic reactions observed in 13 control patients undergoing stress for reasons other than pancreatitis. In patients with acute pancreatitis, hyperglycemia was associated with inappropriately low serum insulin levels (p < 0.005). Plasma glucagon concentrations were markedly increased in the patients with acute pancreatitis and exceeded control values (p < 0.0001) throughout the 24-hour study period. The lipolytic effect of the inadequate serum insulin concentrations, elevated blood cortisol levels and hyperglucagonemia produced in a rise in nonesterified fatty acid levels. Serum gastin and growth hormone measurements remained within the normal range. Plasma parathyroid hormone (PTH) and calcitonin concentrations were increased in both patient populations, although calcitonin levels in patients with pancreatitis were significantly lower than those in the control group (p < 0.001). In patients experiencing a recurrent attack of pancreatitis, plasma glucagon levels were low (p < 0.005) compared with levels in patients experiencing their first episode of acute pancreatitis. Appreciation of the metabolic derangements in acute pancreatitis that are independent of the normal metabolic changes which occur in response to stress will help to rationalize exogenous endocrine therapy and possibly the prognostic accuracy in this disease.